Laser therapy is a treatment for nail fungus infection (onychomycosis). Fungal nail infections usually require several laser treatment sessions before they improve. It may take three to 18 months of consistent treatment for laser treatment for toenail fungus to be effective.
Laser treatments for toenail fungus are considered safe but may cause side effects such as pain and/or bleeding of the area around the nail. Laser therapy is approved by the US Food and Drug Administration (FDA) for the treatment of toenail fungus.
This article will cover what you need to know about using laser treatments for nail fungus.
Benefits
Several types of laser devices are FDA-approved to treat toenail fungus, including the PinPointe Footlaser, GenesisPlus, and Noveon. According to the FDA’s approval criteria, these devices may cause a “temporary increase in clear nails in patients with onychomycosis.”
With laser treatment, most people see noticeable improvement and there is a high cure rate. One study showed a 61% cure rate at 16 weeks. Another study showed a 91% clinical improvement and a 30% cure rate at 180 days.
Laser therapy is associated with high rates of negative cultures. This means that a laboratory test for a fungal infection shows no evidence of infection after treatment.
Treatment of onychomycosis is considered effective when the symptoms of the infection improve and there is no evidence of fungus in cultured samples of the toe or the skin around it.
How laser treatments work for nail fungus
There are several types of laser treatments that can be used to treat toenail fungus, including some that use light and others that use carbon dioxide (CO2).
Laser devices emit pulses of energy that produce heat. When used to treat onychomycosis, the laser is directed so that the heat penetrates the toenail into the nail bed where the fungus is.
For this type of treatment, CO2 lasers or yttrium-aluminum-garnet (YAG) lasers with wavelengths of 870 nm, 930 nm or 1320 nm are used.
In response to the heat, the infected tissue turns to gas and breaks down, destroying the fungus as well as the surrounding skin and nails. The heat from the lasers also has a sterilizing effect, which helps prevent the growth of new fungi.
When the laser is aimed at the area of infection, the heat produced inhibits the growth of the fungus and destroys it.
When used safely, laser therapy does not emit enough energy to cause damage all the tissue or the entire infection. Therefore, repeated treatments are usually required. According to a study of 56 people with onychomycosis, it took an average of four treatment sessions to eliminate nail fungus.
Fungal growth is inhibited and some of the fungal organisms are destroyed, but since the infection can partially survive the treatment, it is unlikely that you will be completely cured of nail fungus with a single laser treatment session.
Who performs laser nail treatments for nail fungus?
Laser toenail treatments for toenail fungus are performed by a cosmetic dermatologist. Because the treatment is considered a cosmetic procedure, you will need to find a dermatologist who will perform cosmetic treatments (eg chemical peels, tattoo removal, botox injections).
When searching for a cosmetic dermatologist, look for the following:
- Board Certification: A board-certified dermatologist is trained and qualified to treat skin conditions.
- Special certification: Look for a dermatologist who has specialized training and experience in laser nail fungus treatment. You should see “laser nail fungus treatment” or something similar clearly listed on the provider’s website.
- Testimonials: Scan a provider’s reviews and testimonials to understand what to expect when you visit their office. Search for hygiene, cleanliness and patient satisfaction reviews and scan for other reviews related to laser treatments.
- Consultations: Cosmetic dermatologists should always offer a free or low-cost consultation before approving you for treatment. The consultation allows them to check your skin thoroughly and make sure that laser treatment is right for you.
If you’re still unsure how to find a board-certified cosmetic dermatologist, consult a healthcare provider for recommendations.
Security
Laser treatment for toenail fungus has an excellent safety record. Unlike traditional nail fungus treatments, such as oral or topical antifungal medications, lasers are not known to cause adverse drug interactions, reactions, or allergic responses.
Laser treatment for toenail fungus is also considered a safe alternative for people with kidney or liver disease, diabetes, or who do not tolerate medications well.
Risks and Side Effects
Possible side effects of laser nail fungus treatment include:
- A mild to moderate but tolerable burning sensation during treatment
- Bleeding, which occurs rarely and decreases with decreasing laser intensity
When laser treatment is done properly by a trained and certified dermatologist, it is very unlikely to harm the nail or the surrounding skin.
However, if the treatment is done with too much intensity, the laser can penetrate the nail and injure the nail bed. This can potentially lead to the formation of a thank you under the nail, a type of scab-like sore made up of dry, dead tissue. It may be red to brown and tender and may bleed easily.
Getting treatment from a qualified and experienced provider greatly reduces this risk.
Alternative cure
Laser treatments are usually more effective than other nail fungus treatments.
A nail fungus infection can sometimes be treated with topical (on the skin) antifungal medications or oral antifungals. There are also over-the-counter (OTC) and prescription options.
Antifungals taken by mouth (by mouth) can cause side effects throughout the body (systemic) and do not necessarily cure toenail fungus. Topical treatments are generally considered safe but may not be effective.
Research has shown that there is about a 45% improvement in toenail fungus with topical medications and about a 40% to 66% improvement with oral medications.
However, there seems to be a range in terms of how well these different treatments work. Using them continuously while avoiding side effects can be difficult. Combining treatments may be more effective than using a single treatment.
What to expect
Laser treatment for toenail fungus can usually be completed within one or two sessions. The laser procedure itself is quick and simple, usually taking about 30 minutes to complete.
Preparation for laser treatment
At your first laser nail fungus treatment consultation, your provider will ask about your symptoms. Typically, onychomycosis is diagnosed based on the appearance of the nail, but they may want to take a sample to look at it under a microscope.
Your treatment will be administered by a dermatologist. You may also have a procedure to trim your toenails and clean away dead skin (exfoliation) on the day of the laser treatment or a few days before.
Just before your procedure, your leg will be cleaned with a sterile solution and placed in an accessible position so the provider can direct the laser.
During the process
No anesthesia is required for laser nail fungus treatment. Once your nail is prepped, the dermatologist will pulse the laser using selected wavelengths. This helps minimize heat to the skin and reduces the risk of side effects.
As the tissue breaks down, you may have some pain and/or bleeding. If the pain is too much for you to tolerate, let your dermatologist know so they can adjust the laser settings.
Recovery
Once the procedure is complete, the dermatologist will tell you how to keep your finger clean and dry as it heals. The provider may give you a topical antifungal cream, such as tioconazole, to apply to the nail. Make sure you follow the provider’s instructions carefully.
The skin will heal in a few days. Any additional treatment sessions are usually two to six weeks apart.
Even effective treatments are not expected to clear up an infected nail right away – it can take up to 18 months for the nail to grow before you can tell if the treatment was successful.
Signs of nail fungus improvement after laser treatment include:
- The disappearance of yellow, white or brown discoloration of the affected toenail or toenails
- Analysis of scaly residue under or on the nail
- Recovery of nail detachment from the bottom of the nail (onycholysis)
- Normal shape and texture of new nail growth without further thickness, bumps or altered nail shape
Does insurance cover laser nail treatment?
Laser nail fungus treatment is considered an elective, cosmetic procedure. Unfortunately, cosmetic procedures are not covered by health insurance. The cost of treatment depends on the severity of the infection, the number of nails affected and the number of sessions required. In general, expect to pay between $100 and $400 per treatment session.
Summary
Several types of laser therapy can treat toenail fungus. Laser treatment has a low risk of side effects, but you may experience burning or pain during the treatment. After the procedure, you will need to wait for your nails to grow out before you see improvement. It may take several treatment sessions to completely clear the toenail fungus.
Laser toenail fungus treatment should be performed by a board-certified dermatologist experienced in the procedure. There are also other treatments you can try for toenail fungus, such as OTC and prescription topical and oral medications, but they may take longer than laser treatment and are often less effective.
